GI-Surgery Flashcards by Beth A

Headache, vomiting, focal neurologic deficit : Indication? Next step in Management?

Increased ICP

- MRI of the brain

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Elderly, intermittent hematochezia, anemia, fever, LLQ pain,

Diverticulitis ( common in sigmoid colon, associated with constipation)

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Oil cysts on mammography after chest trauma. Next step in management (NSIM)?

Reassurance- It is pathognomonic for fat necrosis of the breast. Biopsy confirmation:foam cells and multinucleate giant cells

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Drugs that decrease intestinal motility (2 listed)

amlodipine, chlorpromazine

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abd distention and marked dilation of the colon and cecum on imaging indicates? possible causes?

acute megacolon; complication of interventional procedures and/or SE of medications that decrease motility

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Acute N/V, bloating, absent bowel sound, and uniform gas pattern in small bowel, colon and rectum without air-fluid level on x-ray is

paralytic ileum

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Connects the lesser curvature of the stomach with liver and must be cut in surgery to access for removal of pancreatic tumor

gastrohepatic ligament

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Tx for refractory ascites that has not responded to diuretics? consider complication?

large-volume paracentesis, albumin level (electrolyte abnormalities)

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Sign of mechanical obstruction and X-ray with accumulation of gas in the biliary system (Pneumobilia) and dilated bowel with air-fluid levels is?

Cholecystoentreic fistula

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Salmon-colored fluid from incisional wound after open abd surgery? NSIM?

wound dehiscence; secure wound with tape & abd binding and OR

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fever, abd pain, changes in mental status, ascites fluid with >250 polymorphonuclear leukocytes/mm3 is

Spontaneous Bacterial peritonitis (SBP)

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Tarry stool, BP 90/50, HR 110, on naproxen, Dx? NSIM?

Upper GI bleeding, EGD

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4YO, acute intermittent umbilical abd pain, , draws up his knees to the chest when in pain, Hgb 10.6, abd US with concentric rings of bowel in transverse section, Dx? Pathological lead point?

Intussusception, Meckel’s diverticulum (older than 3 think lead point)

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5YO, abd pain, hyperactive bowel sounds, US normal, Dx? NSIM?

constipation, give polyethyelene glycol

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10YO, Vomiting, RLQ pain without guarding, normal BS, Leukocyte count 12,800. Dx? Imaging?

Acute appendicitis; abd ultrasound for children

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36, fatigue for 4 month, generalized itching, ALK 480, AMA antibody +, ANA +, abd US gallbladder sludge, Dx? NSIM?

Primary biliary cholangitis (PBC), Ursodeoxycholic acid ( 1st line therapy)

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26, fatigue for 6 months, diarrhea for 5 weeks with occasional bloody, ESR 80, Dx? NSIM?

Inflammatory bowel disease; colonoscopy (used for IBD, colorectal cancer screening and diagnosing)

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On colonoscopy; inflamed, reddened mucosa, bleeding on contact with then endoscope, and fibrin-covered ulcers. Dx?

Ulcerative colitis

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66F, profuse watery diarrhea with streaks of blood, UTI 3 weeks ago, 14 day course of ciprofloxacin, N/V, leukocytosis. Dx? Abd xray will show?

Toxic megacolon-complication of pseudomembranous colitis, abdXray- dilation of the colon with loss of haustration

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treatment for intussusception

Air enema or hydrostatic enema

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treatment for nonmetastastatic pancreatic head carcinoma

Whipple procedure- Pancreaticoduodenectomy

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32m, Crohn’s disease with small bowel resection for midgut volvulus at birth, laparotomy with two discrete strictures in the mid-ileum. NSIM? Two things pt at risk for?

Strictureplasty of individual strictures; risk for short bowel syndrome (prior SB reception hx) & adhesions/fistulas (crohn’s disease hx)

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56F, difficulty swallowing solid and now liquid, wt loss, smoker, Esophageal manometry monitoring shows lower esophageal sphincter fails to relax. Dx? NSIM?

Achalasia; Gastroesophageal endoscopy. It can present as distal esophageal cancer also achalasia predisposes to cancer

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Surgical procedure for GERD

Myotomy of LES with fundoplication

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Screening test for C-diff ( 3)

- Enzyme immunoassay (EIA) for glutamate dehydrogenase antigen ( GDH); - PCR testing; - bacterial culture; - Fecal lactoferrin (Not specific enough to confirm diagnosis)

Testing for malabsorption

stool acidity test

Testing for Inflammatory bowel disease (IBD)

Fecal lactoferrin

unstable pt with severe retrosternal pain radiating to the back and left shoulder, nonbillious vomiting, hx of daily beer, crepitus over the thorax. Dx?Appropriate test? and what if pt is stable ?

- Boerhaave syndrome - CT scan of the chest (unstable) - Contrast esophagram with gastrografin (NO barium)

Pt close proximity with animals, RUQ abd pain, N/V, eosinophilia, Liver cysts on US. Dx? Tx? SE?

Hydatid cyst disease (echinococcosis): albendazole SE Leukopenia (CBC q2weeks during therapy)

Hypoechoic heterogenous lesion at the caudal border of liver with surrounding hyperemia. RUQ pain, fever, elevated LFT, leukocytosis. Dx? NSIM

Pyogenic liver abscess; percutaneous draining (if less than 3cm and pt stable tx with abx only)

secondary prophylaxis to prevent variceal bleeding is ? using?

Variceal ligation: using Endoscopic variceal ligation (EVL) q 1-2 weeks until the variceal have been obliterated then 3-6 months endoscoping exam

Tx of acute variceal hemorrhage but not for secondary prophylxis due to drug tolerance (down regulation of receptors)

Octreotide (splanchnic vasoconstriction)

32M, hx HTN & ulcerative colitis , generalized fatigue and severe pruritus, abd US focal bile duct dilation, elevated conjugated bilirubin & ALK pha. DX?

Primary sclerosing cholangitis

32F, hx HTN & ulcerative colitis , generalized fatigue and severe pruritus, abd US focal bile duct dilation, elevated conjugated bilirubin & ALK pha + antimitochondrial antibodies. DX?

Primary biliary cholangitis (PBC)

CP radiating to the back, Tachy, Tachypnea, crepitus over the chest, endoscopic procedure one day ago. Dx?

esophageal perforation

What is the most likely cause of postop hemorrhage within 24hr after surgery in pt with normal coagulation parameter?

Insufficient mechanical hemostasis due to slipped suture or tie

fever, malaise, tender abd, raised amylase, lipase following an episode of acute pancreatitis, abd US with complex cystic fluid collection with irregular walls and septations in pancrease. Dx?

Pancreatic abscess

fever, malaise, tender abd, raised amylase, lipase following an episode of acute pancreatitis, abd US anechoic or hypoechoic, smooth, round structure. Dx

Pancreatic pseudocyst

22F, Chronic abd pain, bloody diarrhea, wt loss, procititis, + p-ANCA. Dx? Colonoscopy will show?

Ulcerative colitis; confluent inflammation of the colonic mucosa with edema, linear ulcers and loss of vascular pattern

upper abd pain, achy and crackling with every heartbeat associated with lucency of the mediastinum is called? diagnosis? How to diagnose?

Mediastinal emphysema (Hamman's sign); iatrogenic esophageal perforation (after upper endoscopy); contrast esophagography with gastrografin

new born, with Polydromnios before birth, cyanotic attack that does not improve with crying suggests?

developmental anomaly, esophageal atresia

1st line therapy to treat initial episode of C-diff infection

- Oral fidaxomicin or oral Vancomycin

Why LR and not NS?

LR reduces the risk of SIRS and large quantities of NS can cause non-anion gap hypercholoremic acidosis

54M, Abd distension with shifting dullness, cloudy ascitic fluid, serum-ascites albumin gradient (SAAG) < 1.1 and Triglycerine count >200, non-pitting pedal edema is

Lymphedema (Chylous ascties) caused by Lymphoma

68M, increased in the frequency of bowel movement and occasional bloody stools, smoker, digital rectal exam shows a large internal hemorrhoid, stool + for occult blood, NSIM?

colonoscopy

what disease could cause chronic, progressive changes in bowel habits and hematochezia in an elderly man with a history of smoking?

Colorectal cancer

What lab test helps determine the severity of pancreatitis quickly?

Hematocrit (severity), Lipase is good for diagnosis but correlated poorly with disease severity

Tx for acute diverticulitis complicated by a large abscess (>3cm) is

CT-guided percutaneous drainage

Young boy with painless lower GI bleeding, DX? NSIM?

Meckel Diverticulum, Technetium-99m pertechnetate scan

1st-line treatment for an obstructing Schatzki ring/esophageal ring is

mechanical dilation using bougie or ballon dilators

Dysphagia, esophageal obstruction, ring like appearance of obstruction with normal mucosa on biopsy is

Schatzki ring

Achlohydria, overgrowth of nitrite-producing bacteria, and reflux of bile through the gastrojeunal anastomosis after partial gastrectomy will have risk for

gastric cancer

name for absent of HCL in gastric is called

achlorhydria

secretory diarrhea, episodic cutaneous flushing, abd pain, heart valve dysfunction, and wheezing

Carcinoid syndrome due to excess serotonin recreation from Carcinoid tumor

Young woman on oral contraceptive pill with 3cm hepatic mass. Dx? NSIM?

hepatic adenomas, reimagined in 6 month after stoping oral contraceptives (OCPs)

Ingestion Scerotherapy is used for tx of

rectal prolapse

Tx of anogenital warts (condylomata acuminate)

Local cytostatic 5-fluorouracil therapy

Tx of choice for pt with anal SSC cancer is

Radiochemotherapy, shown to be superior to surgery

Elderly, hx of multiple medical conditions, with abd pain and distention. Imaging colonic dilation with haustral preservation in absence of an obstructing lesion is

acute colonic pseudo-obstruction (oglivie syndrome)

Disease of GI characterized by impairment of the autonomic nervous system

Oglivie syndrome

How do you treat Oglivie syndrome

Neostigmine therapy- causes increase in acetylcholine to stimulate bowel peristalsis

Viscous, dark green substance draining after 12hrs abd surgery, Dx? NSIM?

enterocutanous fistula, Total parenteral nutrition and stony pouch

Risk factors of cholecystitis

``` Female Fat Forty Fair-skinned Family history Fertile (Multiparity) ```

Tx of acute Acalculous cholecystitis

1. IV fluid 2. Broad-spectrum antibiotics (piperacilin-tazobactam) 3. Cholecystostomy

Bulimic pt with retrosternal pain and leakage of contrast from lower esophagus after serval episode of vomiting. No sepsis, pneumothorax, pleural effusion or mediastinal emphysema, leak contained to the mediastinum. Dx? Tx?

Boerhaave syndrome, IV ampicillin therapy . | Surgical repair only if therapy fails or sever tear

17M, Progressive high fever, leukocytosis, add pain and abd fluid collection seen on CT in right pelvis, Dx? NSIM?

appendices abscess, Continue conservative management (bowel rest, IV fluids, and abx) and schedule appendectomy in 6-8 weeks

Elevated cholestatic parameters and a dilated common bile duct without evidence of stones in the biliary system after cholecystectomy. Dx? Tx?

``` Postcholecystectomy syndrome( residual gallstones within biliary tree or sphincter of oddi dysfunction) - ERCP with sphincterotomy ```

Down syndrome new born with bilious vomiting, abd distention, explosive stool release upon rectal exam, late passage of meconium.Dx? NSIM?

Hirschsprung's disease; Rectal suction biopsy ( 2cm proximal to the dectate line)

Recommended procedure for pt with hematochezia and hemodynamic instability despite resuscitation efforts

Angiography

Mutation in mismatch repair genes(MLH1, MSH2)- Lynch syndrome risk of developing 3 different cancers

- Colorectal - Gastric - Endometrial (might require Hysterectomy and bilateral salpingo-oophorectomy

Newborn with abd distention, multiple episodes of billow vomiting, and dilated large bowel loop, delayed passage of meconium, absent of air in the rectum, and narrow sigmoid colon with dilated colon segment on x-ray suggest

Hirschsprung's disease

Defective migration of neural crest cells

Hirschsprung's disease

Gastric outlet obstruction (GOO) caused by ACUTE peptic ulcer disease causes vomiting from

inflammation-induced edema | tissue deformation of the gastroduodenal junction

Gastric outlet obstruction (GOO) caused by Chronic peptic ulcer disease related to H.Pylori-induced chronic gastritis & chronic NSAID use causes vomiting due to

scarring and tissue remodeling

Changes in Na, pH, K, Cl from vomiting from pyloric stenosis in the early stages of dehydration

Na (hyponatremia), pH(normal in early stage due to respiratory and kidney compensation), K ( Normal), Cl (normal)

Triple bubble sign in a new born with bilious vomiting

Jejunal atresia

Double bubble sign in a new born with bilious vomiting

Duodenal atresia

What would be the best approach to evaluate abdominal injuries in a hemodynamically unstable patient with inconclusive FAST test?

Diagnostic peritoneal lavage (DPL)

Abd X-ray on a new born low birth weight with pneumatosis intersitnalis (gas within the wall of the intestine) is indicative of? NSIM?

Necrotizing enterocolitis; Exploratory laparotomy

Indication for familial adenomatous polyposis (FAP) is

proctocolectomy with ileana anastomosis

A smooth, bony hard, and nontender mass in the midline of the hard palate is

torus palatines-benign bone tumor

Crepitus in the abd wall and thickened gallbladder with gas

emphysematous cholecystitis

US with bile duct wall thickening and focal strictures and dilations of the interahepatic and extra hepatic bile ducts

Primary Sclerosing Cholangitis (PSC)

neonate with acute-onset bilious vomiting, mildly distended abd, no gas in the small intestine on x-ray, Dx? NSIM?

Intestinal malrotation with midgut volvulus (misplaced ligament of Treitz and duodenojejunal auction on the right of the mid-line) Upper GI contrast series

Obvious signs of malrotations are

misplaced ligament of Treitz and duodenojejunal junction on the right of the mid-line

Recommended treatment of chronic pancreatitis

pancreatic enzyme therapy

Bloody diarrhea and cramps abd pain

Inflammatory Bowel disease

Friable and inflamed mucosa that bleeds on colonoscopy Dx?, Tx?

- ulcerative colitis; | - Mesalamine therapy (for mild UC), 5-aminosalicyclic acid derivatives (sulfasalazine and olsalazine)

Therapy only for management of steroid-refractory UC in pt not willing to have surgery and who have contraindication for calcineurin inhibitors

infliximab therapy

Therapy for Crohn's disease

Infliximab

A prognostic grading scale for cirrhosis (mortality)

Child-Pugh score /CTP score (Child-Turcotte-Pugh score) | on the bases of; bilirubin, albumin, PT and degree of cities and encephalopathy (Graded A-mild to C-severe)

Higher CTP score on cirrhotic patient with ascites who need surgery, what you should be done to prevent surgical morbidity?

abd paracentesis

abd pain and distention with obstipation, x-ray with coffee-bean sign indicates? NSIM?

``` Sigmoid volvulus endoscopic detorsion (via sigmoidoscopy) ```

1st line of tx for gastroparesis

Metoclopramide (Reglan)

Abd x-ray with cecal and right colon dilation, Dx? Tx?

colonic pseudo-obstruction, neostigmine therapy

Congenital umbilical hernias close spontaneously by what age?

Pt with cholecystitis needs what therapy before lap cholecystectomy?

Antibiotic therapy- Piperacillin-tazbactam IV (Zosyn)

Emergent open cholecystectomy is indicated for (2)

gangrenous cholecystitis or gallbladder empyema

Trauma pt with paralytic ileum (tx opioids), ileum with bilateral flank pain, seatbelt sign, Grey Turner sign, obliteration of the psoas outline on x-ray and fluid-responsive hemodynamic changes make?

retroperitoneal hemorrhage

Flank ecchymosis due to retroperitoneal bleeding dissecting through fascial planes is called

Grey Turner's sign

Five days after pancreaticoduodenectomy presenting with hyperchloremic normal anion gap metabolic acidosis needing testing of drain fluid for amylase is due to

Pancreatic fistula

Tx for pancreatic fistula include

-conservational tx (Octreotide, TPN) or with stunting of the pancreatic duct

Fever, jaundice, & RUQ abd pain is called

Charcot's triad

right upper abd pain on pregnant women who has vomiting, fever, leukocytosis and mild pyuria

Appendicitis- gravida uterus can displace the appendix to the RUQ. Pyuria if appendicitis is proximal to ureters

Vomiting, abd pain, RUQ tenderness in pregnant women with high LFT, hemolysis and low plt. Dx?

HEELP syndrome

Initial management of bleeding esophageal varies involves (4)

- Fluid resuscitation - blood product to stabilize coagulation - octerotide - prophylactic abx

When should Endoscopic band ligation be performed on a patient with esophageal varies

within 12 hrs of presentation, after medical treatment and prophylaxis

4 weeks old infant with scleral icterus and play stools suggests

direct hyperbilirubinemia (biliary atresia)

Immediately following birth child with jaundice, normal stool color is

indirect hyperbilirubinemia (Crigler-Najjar syndrome)

Pregnant women with pruritus, elevated direct bilirubin levels, elevated bile acid indicates

intrahepatic cholestasis of pregnancy

After 1 day of MVA abd pain, nausea and vomiting. X-ray with large gastric bubble with mild gastric distention. Dx? Tx?

- Duodenal hematomas causing upper intestinal obstruction | - NG decompression and TPN

Epigastric pain, N/V and history of multiple episodes of acute pancreatitis with walled off pancreatic fluid on CT, Dx? Tx?

- Pancreatic pseudocyst | - CT-guided percutaneous drainage

Pt of Asian descent with saccular or fusiform dilation of the biliary tree or as a dilated masses that communicate with the biliary tree is

Biliary cysts

MVA 8hrs ago, HR 140, bp 80/50, CVP 19, JVD, abd is tense and distended;Dx? NSIM?

- Abd compartment syndrome (from resuscitation) | - Reopen abd and cover with plastic

Sudden compromises of blood flow to bowel causing necrosis and infection

Ischemic colitis (absent bowel sound , tenderness in palpation of all quadrant, x-ray with air-filled distended bowel)

When direct and indirect hernias happen together, it is called

Pantaloon or Saddle bag hernia

GI-Surgery Flashcards

(116 cards)